Endurance Runners and Travel

Abstract & Commentary

Synopsis: Why are so many Olympic level endurance athletes from East Africa? A demographic review of Ethiopians suggests that both heritage and habit are important. Travel medicine providers can provide customized care to runners to protect them from particular risks during international travel.

Source: Scott RA, et al. Demographic Characteristics of Elite Ethiopian Endurance Runners. Medicine and Science in Sports and Exercise. 35:1727-1732, 2003.

Summary: three groups of ethiopian athletes (long distance runners, shorter distance runners, sprinters, and field events contestants) were compared with an otherwise similar population of non-athletes. Distance runners were more likely to be from particular highland geographical areas (Arsi and Shewa), to have a specific minority ethnicity (primary language of Cushitic origin), to have longer daily commutes to school, and to run to and from school.

Comment by Philip Fischer, MD, DTM&H

This summer, Olympic spirit takes our minds toward international cooperation, foreign travel, and athletic involvement. Already, Travel Medicine Advisor has historical links to distance running. The current editor successfully completed the Washington Marine Corps Marathon a decade ago. The former managing editor ran a marathon on an Atlantic island. With another of the associate editors, I ran between tea fields in Kenya earlier this year. What can we learn from international distance runners that would help us all here at home, and what particular cares should we provide to runners who present for pre-travel consultation?

People run for lots of reasons. Initially, distance runners were messengers. Biblical runners were said to have "beautiful feet" as they carried news of salvation.1 The legendary (and likely fictional) Pheidippides died as he presented military news at the conclusion of what some think was the original 26.2 mile marathon to Athens. Eric Lidel of Chariots of Fire fame ran because he felt God’s pleasure, while others choose to run for either endorphin surges or ego satisfaction. More and more, however, non-elite athletes run marathons, and they often claim health benefits as a motivating influence.

The lay press laments the American obesity epidemic,2 and many sources urge us all to get frequent, regular aerobic exercise.3 This usually translates into something new to add to our already full schedules. The Ethiopian study, however, reminds us that regular exercise can be incorporated into our daily activities rather than simply added on. Most of us already spend time commuting; why not commute by foot? A study comparing Kenyans and Scandinavians showed that adolescents who walk or run to school, even without formal athletic training, have 30% more efficient oxygen use than do their sedentary colleagues; intense training in adolescence further increased exercise capacity.4 Perhaps as a practical beginning, we could walk up stairs rather than use elevators, and we could walk through airports rather than using moving sidewalks. Whether we ever want to run a marathon or not, incorporating regular aerobic activity into our lives can lead to improved physiology. "Travel" medicine can be relevant to "journeys" of even a few steps.

What can we suggest to runners who travel internationally? How might we provide them specific input as they seek pre-travel consultation? Does travel impede athletic performance? There is some evidence that travel across 6 or more time zones is linked to decreased running performance, strength, and endurance,5,6 and that there are differences in tolerance of east-to-west vs west-to-east travel.7 Part of the "home field advantage" in American sports might also relate to decreased performance of visiting athletes who had traveled eastward, and performance potentials do not fully normalize until 5 days after arrival in the new time zone.8

One runner wanted to get some exercise while waiting between legs of flights in Addis Ababa. Leaving his carry-on bags with friends, he took his passport and boarding pass and left the airport for a bit of exercise. Everything went smoothly until he tried to rejoin his traveling companions—he had neglected to carry cash to pay the departure tax for those entering the airport to leave the country. We should remind traveling runners to make sure they carry necessary documentation and money during layover runs, and that they allow adequate time to complete security and immigration procedures after running.

Whether on a layover or relocating, how can travelers find good places to run in other countries? I asked a woman at the information desk in Amsterdam’s Schiphol airport how far it was on the ubiquitous bicycle trails from the airport to the city center. "Impossible," she replied. "You can’t get there from here on foot." Exploring by trial and error, I have since learned that it is possible to run from Schiphol to the downtown train station for a ride back to the airport, and there are plenty of other fine places to run in Holland as well. Schiphol also has showers (free in the restrooms near the business center but you need your own soap and towel and might not have hot water; about $12 with comfort, space, soap, and shampoo at the Hotel Mercure near the F concourse) for post-run refreshment before getting back on the plane.

Stretching my legs in the back of a 747 headed to Japan, I read the airline’s copy of the May 2004 issue of Runner’s World. It had a nice article about places to run in Tokyo. That was great, but I was only spending 2 hours at the Narita airport on my way to Beijing. Besides asking at hotels and launching out adventurously, where is there information about running routes? The internet, at http://runtheplanet.com, lists peer-recommended routes in most countries and major cities of the world. This web site also provides some contacts of potential running companions.

I’ve seen American women running with pants on under their long skirts in central Africa, and I thought they looked pretty funny. This, however, was acceptable to the local population—many of whom would have been highly offended to see women wearing shorts or even "just" pants on their legs in public. Travel Medicine Advisor’s Culturegram information sheets give good background information on what sorts of attire and recreational activities are common and appropriate in specific foreign settings.

My own recent 18-week marathon training program coincided with enough foreign travel that I was able to take training runs on 4 different continents. Did my running put me at risk for any particular illness? Only in the United States has a dog bitten me during a run, but I have had dogs chase me through streets in Bangladesh and India. In China recently, the Pekingese I noticed were all calm and leashed, but a local paper still listed rabies high on a list of important health problems. Runners, even on short trips to urban areas of developing countries, could be considered to be at increased risk of rabies and should consider immunization—with careful instruction, as well to also seek immediate medical care in the event of a bite.

Lacking data comparing travel-related health symptoms in runners and non-runners, one might imagine that runners fare better than more sedentary travelers. Regular exercise seems to help some people adapt more quickly to new time zones, and it would be interesting to know if runners experience less jet lag than non-runners. Similarly, runners are keenly aware of the need to be carefully attentive to food and fluid intake, and one might postulate that they are able to more easily comply with hygienic advice designed to prevent travelers’ diarrhea. Perhaps this summer’s Olympic travel and athleticism will stimulate further study of the relative risks of travel health problems in athletes.


1. The Bible. Isaiah 52:7 and Romans 10:15.

2. http://abcnews.go.com/sections/living/US/obesity_subindex.html

3. Brooks GA, et al. Chronicle of the Institute of Medicine Physical Activity Recommendation: How a Physical Activity Recommendation Came to be Among Dietary Recommendations. Am J Clin Nutr. 2004;79(suppl):921S-930S.

4. Saltin B, et al. Aerobic Exercise Capacity at Sea Level and at Altitude in Kenyan Boys, Junior and Senior Runners Compared with Scandinavian Runners. Scand J Med Sci Sports. 1995;5:209-221.

5. O’Connor PJ, et al. Athletic Performance Following Rapid Traversal of Multiple Time Zones. A Review. Sports Med. 1990;10:20-30.

6. Hill DW, et al. Effects of Jet Lag on Factors Related to Sport Performance. Can J Appl Physiol. 1993; 18:91-103.

7. Lemmer B, et al. Jet Lag in Athletes After Eastward and Westward Time-Zone Transition. Chronobiol Int. 2002;19:743-764.

8. Manfredini R, et al. Circadian Rhythms, Athletic Performance, and Jet Lag. Br J Sports Med. 1998;32:101-106.

Philip R. Fischer, MD, DTM&H, Professor of Pediatrics, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN, and Associate Editor of Travel Medicine Advisor.